The surgical management of non-malignant aerodigestive fistula
Abstract Background Acquired aerodigestive fistula (ADF) are rare, but associated with significant morbidity. Surgery affords the best prospect of cure. We present our experience of the surgical management of ADFs at a specialist unit, highlighting operative techniques, challenges and assess clinica...
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| Format: | Article |
| Language: | English |
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BMC
2018-11-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13019-018-0799-1 |
| _version_ | 1828316429101826048 |
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| author | Yassar A. Qureshi M. Muntzer Mughal Sheraz R. Markar Borzoueh Mohammadi Jeremy George Martin Hayward David Lawrence |
| author_facet | Yassar A. Qureshi M. Muntzer Mughal Sheraz R. Markar Borzoueh Mohammadi Jeremy George Martin Hayward David Lawrence |
| author_sort | Yassar A. Qureshi |
| collection | DOAJ |
| description | Abstract Background Acquired aerodigestive fistula (ADF) are rare, but associated with significant morbidity. Surgery affords the best prospect of cure. We present our experience of the surgical management of ADFs at a specialist unit, highlighting operative techniques, challenges and assess clinical outcomes following intervention. We also illustrate findings of a Hospital Episodes Statistics search for ADFs. Methods A prospectively-maintained database was searched to identify all patients diagnosed with an ADF who were managed at our institution. Of 48 patients with an ADF, eight underwent surgical intervention. Results Four patients underwent an exploration of the ADF with primary repair of the defect. Two of these patients had proximal ADFs, amenable to repair through a neck incision, and two required a thoracotomy. Two patients suffered fistulae secondary to endoscopic therapy and underwent oesophageal exclusion surgery, with subsequent staged reconstruction. Two patients with previous Tuberculosis had a lung segmentectomy and lobectomy respectively, and a further patient in remission after treatment for lymphoma underwent oesophageal resection with synchronous reconstruction. Three patients suffered a complication, with one post-operative mortality. The remaining seven patients all achieved normal oral alimentation, with no evidence of ADF recurrence at a median follow-up of 32 months. Conclusions Surgery to manage ADFs is effective in restoring normal alimentation and alleviates soiling of the airway, with a very low risk of recurrence. Several operative techniques can be utilised dependent on the features of the ADF. Early referral to specialist units is advocated, where the expertise to facilitate the complete management of patients is present, within a multi-disciplinary setting. |
| first_indexed | 2024-04-13T17:13:37Z |
| format | Article |
| id | doaj.art-21026792610c4379b656fc6b3540d1c6 |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-04-13T17:13:37Z |
| publishDate | 2018-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-21026792610c4379b656fc6b3540d1c62022-12-22T02:38:11ZengBMCJournal of Cardiothoracic Surgery1749-80902018-11-011311810.1186/s13019-018-0799-1The surgical management of non-malignant aerodigestive fistulaYassar A. Qureshi0M. Muntzer Mughal1Sheraz R. Markar2Borzoueh Mohammadi3Jeremy George4Martin Hayward5David Lawrence6Department of Oesophago-Gastric Surgery, University College London HospitalDepartment of Oesophago-Gastric Surgery, University College London HospitalDepartment of Surgery and Cancer, Imperial College LondonDepartment of Oesophago-Gastric Surgery, University College London HospitalDepartment of Thoracic Medicine, University College London HospitalDepartment of Thoracic Surgery, University College London HospitalDepartment of Thoracic Surgery, University College London HospitalAbstract Background Acquired aerodigestive fistula (ADF) are rare, but associated with significant morbidity. Surgery affords the best prospect of cure. We present our experience of the surgical management of ADFs at a specialist unit, highlighting operative techniques, challenges and assess clinical outcomes following intervention. We also illustrate findings of a Hospital Episodes Statistics search for ADFs. Methods A prospectively-maintained database was searched to identify all patients diagnosed with an ADF who were managed at our institution. Of 48 patients with an ADF, eight underwent surgical intervention. Results Four patients underwent an exploration of the ADF with primary repair of the defect. Two of these patients had proximal ADFs, amenable to repair through a neck incision, and two required a thoracotomy. Two patients suffered fistulae secondary to endoscopic therapy and underwent oesophageal exclusion surgery, with subsequent staged reconstruction. Two patients with previous Tuberculosis had a lung segmentectomy and lobectomy respectively, and a further patient in remission after treatment for lymphoma underwent oesophageal resection with synchronous reconstruction. Three patients suffered a complication, with one post-operative mortality. The remaining seven patients all achieved normal oral alimentation, with no evidence of ADF recurrence at a median follow-up of 32 months. Conclusions Surgery to manage ADFs is effective in restoring normal alimentation and alleviates soiling of the airway, with a very low risk of recurrence. Several operative techniques can be utilised dependent on the features of the ADF. Early referral to specialist units is advocated, where the expertise to facilitate the complete management of patients is present, within a multi-disciplinary setting.http://link.springer.com/article/10.1186/s13019-018-0799-1Aerodigestive fistulaTracheo-oesophageal fistulaOesophageal cancerOesophageal surgery |
| spellingShingle | Yassar A. Qureshi M. Muntzer Mughal Sheraz R. Markar Borzoueh Mohammadi Jeremy George Martin Hayward David Lawrence The surgical management of non-malignant aerodigestive fistula Journal of Cardiothoracic Surgery Aerodigestive fistula Tracheo-oesophageal fistula Oesophageal cancer Oesophageal surgery |
| title | The surgical management of non-malignant aerodigestive fistula |
| title_full | The surgical management of non-malignant aerodigestive fistula |
| title_fullStr | The surgical management of non-malignant aerodigestive fistula |
| title_full_unstemmed | The surgical management of non-malignant aerodigestive fistula |
| title_short | The surgical management of non-malignant aerodigestive fistula |
| title_sort | surgical management of non malignant aerodigestive fistula |
| topic | Aerodigestive fistula Tracheo-oesophageal fistula Oesophageal cancer Oesophageal surgery |
| url | http://link.springer.com/article/10.1186/s13019-018-0799-1 |
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